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NPI Code Detail

MEDICARE: DR. JEFFERY WALTERS DDS

MEDICARE: DR. JEFFERY WALTERS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryD4930AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1493578OTHERAZAHCCCS

General Provider Information

NPI Number : 1427085257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFERY WALTERS DDS
Provider Business Mailing Address
First Line : 7006 S CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-5423
Country : US
Telephone Number : 602-276-1029
Fax Number : 602-276-1838
Provider Business Practice Location Address
First Line : 7006 S CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-5423
Country : US
Telephone Number : 602-276-1029
Fax Number : 602-276-1838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/08/2007

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